Any food can produce intolerance, but it does seem that some foods are more likely to be a problem than others. Oranges, for example, are regularly identified as culprit foods, whereas apples are incriminated much less frequently. Yet apples and oranges are probably eaten in roughly equivalent quantities. Similarly, wheat appears to be a more potent cause of intolerance than other cereals. However, the idea that some foods are completely ‘safe’ and can never produce food intolerance is wrong – this claim is sometimes made by alternative therapists, particularly those ‘dietary therapists’ who emphasize the supposedly magical qualities of rice.

The general pattern of food intolerance seems to be as follows. The patient begins with sensitivity to milk, wheat, maize, eggs or some other commonly eaten food. At this stage, they probably have just one or two minor symptoms. As time goes by, new sensitivities appear, to foods that are eaten less often. With new sensitivities come new symptoms and the person’s health deteriorates. In those who have had food intolerance for many years, a large number of foods may be at fault – sometimes as many as 20 or 30. Such people tend to be quite severely affected by their symptoms, to the extent that they cannot lead a normal life. However, these cases are a minority. Most people who need treatment for food intolerance are sensitive to between one and five foods, and they are able to function quite well, despite their illness.

The amount of food needed to provoke symptoms is generally much larger in intolerance than in allergy. Someone with true food allergy may react to a single drop of milk; or a trace of food left in a cooking utensil. One young man who was allergic to fish even fell victim to his girlfriend’s kiss – she had eaten fish half an hour beforehand. The food-intolerant individual never shows this sort of ‘exquisite’ sensitivity. They usually need normal-sized portions to provoke a reaction, although some will react to just a few mouthfuls of the food.

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